Waitlist for Resolution Counseling Center
Fill in this form to join our waitlist.  We send 2 emails every week highlighting staff with openings.  If you request a particular therapist(s), we often send emails when they have an opening.  You only need to fill out the waitlist once--you can choose more than 1 provider name.  

Also, you don't have to wait!  We have openings now.  Visit our team page to book anytime.  Or text our office for tips on who to book with at 201-632-5554.  
Sign in to Google to save your progress. Learn more
Name (First and Last) *
Email Address *
Your Phone Number 
Please provide a number we can text and call (ie you are giving consent to be contacted at the number below):  
 *
Services You're Interested In (Check All that Apply) *
Required
Location Preference:  Our offices have not re-opened yet but our therapists are based in different locations (and some are tele-health only).  If you would like to have office appointments in the future, the location could be important. Please select all locations that could work for you: *
Required
What days and times are you available?  Please check all that apply
What state would you expect to be in for the majority of your sessions?
Clear selection
Which Insurance Plan Do You Have?  Resolution Counseling Center is in-network with Aetna, Cigna, Horizon, BCBS, United Healthcare, Optum, Oxford, Meritain, UMR, & 1199 SIEU plans.  We can help you navigate out of network coverage as well.  
Clear selection
If you are inquiring about couples or family counseling, you might have two insurance plans you could use.  If your partner or child has a different plan, tell us the name of their plan below:
Do you prefer to work with a specific therapist?  Check any and all below.   (See https://www.resolutioncc.com/team/)
What age range best captures the intended client(s):
Clear selection
How did you hear about us?  
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Resolution Counseling Center. Report Abuse
Google Forms